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Hemorrhoid Excision

Great Surgical Care at Marina del Rey Hospital

Why Choose Cedars-Sinai Marina del Rey Hospital for Hemorrhoid Excision?

At Cedars-Sinai Marina del Rey Hospital you will receive the patient-centered care what our dedicated medical team is renowned for. This surgical procedure will be performed by our highly skilled colorectal surgeons using only the latest and most advanced technology and techniques. With the pain and discomfort gone your quality of life is going to improve tremendously.

Hemorrhoids consist in the dilatation of the veins that are situated in the anal canal and lower rectum. They form hemorrhoid packages that can reach troublesome sizes and can be externalized through the anus, leading to several complications like bleeding, hemorrhoid thrombosis or prolapse.

Hemorrhoids are classified according to their location: internals, which are situated in the anal canal and are not painful, and externals, which got out of the anal canal and cause a lot of pain. Both of them can lead to more or less bleeding. The main factor that causes the apparition of hemorrhoids is the high pressure in the veins located in the anorectal region. This usually happens during pregnancy, when frequently lifting weights or because of a constipation.

The classic surgical procedure used to treat hemorrhoids is hemorrhoid excision, which can be open or closed. The difference between the two of them consists in closing the anorectal mucosa with sutures or not. This procedure is recommended for patients who do not get better after trying multiple nonsurgical methods and for those who suffer from stage III or IV hemorrhoids.

The frequently met causes of external hemorrhoids are acute or recurrent thrombosis or hygiene problems. The acute and recurrent thrombosis is treated in the same way.

The first step is identifying the thrombosed vein followed by the anesthetic injection. After that, the skin and the corresponding vein are excised.

Treating the thrombosis without removing the vein will lead to the recurrence of the hemorrhoid in the same place.

Therefore, the excision of the vein prevents this event from happening.

Also, recurrence happens in 50% of the cases where the thrombosis is not treated.  

Hemorrhoid excision is contraindicated in several cases:

  • a suspicion that the lesion could be other than a thrombosed hemorrhoid
  • stage IV internal hemorrhoids associated with an external thrombosed hemorrhoid
  • severe coagulation disorders
  • hemodynamic instability
  • allergy to anesthetics
  • perianal infection

After a hemorrhoid excision, sitz baths should be done as soon as possible. The patient should have 3-4 sitz baths a day, each being 20 minutes long, in warm water (not hot). The bandage can be removed after 48 hours if it does not come off by itself.

Acetaminophen or ibuprofen is prescribed for pain and opioids will be avoided as they cause constipation. Antibiotics are not necessary. 

  • Bleeding is the most common complication of this surgical procedure. It can be controlled by direct pressure or an absorbable suture.
  • Infection appears in less than 5% of the cases.
  • Excessive perianal skin is a frequent benign complication after the healing of the incision.   
  • Incontinence is rare and can be prevented by avoiding the external anal sphincter.
  • Pain is common but avoidable using a combination of local and parenteral anesthesia.

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